Applied nutritional investigationAcute effects of beer on endothelial function and hemodynamics: A single-blind, crossover study in healthy volunteers
Introduction
Considerable interest in the cardiovascular (CV) effects of moderate alcohol consumption is evident during the past 30 y [1]. The majority of studies suggest a lower risk for coronary heart disease and all-cause mortality in middle-aged and older adults consuming one to two alcoholic beverages daily [2], [3]. It is suggested that there are several combined, additive, or synergistic effects of alcohol and non-alcoholic components (i.e., antioxidants) found in alcoholic drinks (mostly red wine, beer, and whisky) covering all phases of the atherosclerotic process; endothelial function, arterial stiffening, and atherogenesis as well as coagulation and fibrinolysis [4]. Particularly, the acute and long-term beneficial effects of red wine and its components (alcohol and antioxidants) on endothelial function and hemodynamics have been explored previously in healthy volunteers and patients with coronary artery disease (CAD) [5], [6].
The effect of another widely consumed drink such as beer on arterial function and structure has been inadequately investigated so far. Like red wine, beer contains both ethanol and antioxidant substances [7]. However, ethanol concentration is less than in red wine, whereas its antioxidant content is equivalent but varies on specific antioxidants [7]. Both beer and red wine contain tyrosol, hydroxycinammic acids, such as ferulic and caffeic acids, flavonoids, such as (+)-catechin, (−)- epicatechin and quercetin, and procyanidins, albeit at different concentrations. Beer furthermore contains other important flavonoids, such as formononetin, genistein, daidzein, and kanpherol, as well as hydroxybenzoic acids, which are not present in red wine [7], [8]. As with other alcohol beverages, moderate daily beer consumption appears to be negatively associated with blood pressure (BP) and cardiovascular disease (CVD) but a higher daily dose may have detrimental effects, leading to a J-shape or U-shape relation [9], [10]. A few studies have investigated the effect of beer versus red wine on arterial function [11], [12]. To our knowledge, there are no data regarding the effect of acute beer intake on arterial biomarkers of atherosclerosis (pulse wave velocity [PWV], augmentation index [AΙx], flow-mediated dilation [FMD]) or on aortic pressure [13], [14]. The biomarkers just cited provide a comprehensive non-invasive assessment of early arterial disease, because FMD assesses endothelial dysfunction (i.e., the first step in atheromatosis), PWV provides insight on early aortic stiffening, whereas AIx and aortic BP give complementary information to brachial BP regarding left ventricular afterload [14], [15], [16], [17], [18], [19], [20], [21]; all these biomarkers are independent predictors of risk for CVD. Significant improvements of these markers through drug administration or lifestyle changes have a potential beneficial effect on the atherosclerosis process and reduce CV morbidity/mortality [15], [16], [17], [18], [19], [20], [21], [22].
The aim of this study was to assess for the first time the postprandial effects of beer consumption on arterial function/structure and brachial/aortic BP and to investigate the role of beer’s constituents (alcohol and antioxidants) on these parameters. For that purpose, we compared in a single-blind crossover study, the effects of regular beer, dealcoholized beer, and vodka (containing comparable amount of antioxidants or alcohol) on endothelial function, aortic stiffness, pressure wave reflections, and aortic pressure in apparently healthy non-smoking men. Because data on this issue are lacking, this study will provide significant insight on the potential effect of beer consumption on the CV system.
Section snippets
Study population
Apparently healthy, male non-smokers were invited to participate in the study through a university advertisement and word of mouth. Exclusion criteria were medical history of CAD, diabetes mellitus, liver or endocrine diseases, smoking, alcohol consumption more than the recommended amount (20–30 g/d), vigorous exercise, antioxidant vitamin supplementation, and dieting at the time of the study. The study complied with the Declaration of Helsinki, and was approved by the Laikon Hospital
Results
Seventeen healthy male participants enrolled and completed the study. Their mean age was 28.5 ± 5.2 y and their body mass index 24.4 ± 2.5 kg/m2 (Table 1). Data from 16 men were available for the final analysis due to missing values related to poor quality of vascular recordings in at least one of the visits.
Table 2 shows the changes in PWV, AIx, and FMD as well as in the baseline brachial artery diameter. PWV was significantly (time effect P < 0.001) and similarly (i.e., meal effect was
Discussion
In this study we examined the postprandial effects of beer, dealcoholized beer and vodka, on endothelial function (FMD), aortic stiffness (PWV), pressure wave reflections (AΙx), and aortic/brachial pressure. In order to test the effects of beer’s constituent (alcohol and antioxidants) we matched the quantity of antioxidants in the regular and dealcoholized beer and the quantity of alcohol in the beer and vodka. Beneficial effects were observed in all arterial biomarkers (PWV, AΙx, FMD) by all
Acknowledgements
This work was supported in part by the Graduate Program, Department of Nutrition and Dietetics of Harokopio University, the Institute for Translational Sciences at the University of Texas Medical Branch (supported in part by a Clinical and Translational Science Award (UL1TR000071) from the National Center for Advancing Translational Sciences) and the Sealy Center on Aging, University of Texas Medical Branch at Galveston. We are indebted to the volunteers for their interest and participation in
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KK and AP were involved in the conception and design of the study; analysis and/or interpretation of data; drafting and revision of the manuscript; and approval of the final version of the manuscript. VR was involved in the collection, analysis, and/or interpretation of data; drafting and revision of the manuscript, approval of the final version of the manuscript. AG, KX, and JC took part in the collection of data; drafting and revision of the manuscript and approval of the final version of the manuscript. PS was involved in the analysis and/or interpretation of data; drafting and revision of the manuscript; and approval of the final version of the manuscript. LS was involved in the conception and design of the study; drafting and revision of the manuscript; and approval of the final version of the manuscript. The authors declare that they have no conflict of interest.